Paper of the Week

Incremental Prognostic Significance of Combined Cardiac Magnetic Resonance

Imaging, Adenosine Stress Perfusion, Delayed Enhancement, and Left Ventricular Function Over Preimaging Information for the Prediction of Adverse Events

(Circulation. 2011;123:1509-1518.)

Dr Bingham and cols followed up 908 consecutive patients who underwent combined CMR for suspicion of coronary stenosis and/or ischemia at 2.6_1.2 years, during which 101 total cardiac events occurred (all-cause death, myocardial infarction, or late revascularization). In the studied population, cardiac magnetic resonance imaging without abnormalities had a 2.4% event rate per year (<1% cardiac death or myocardial infarction). Abnormal CMR was associated with event rates of 5.6% to 7.0% per year, varying with which and how many components were abnormal. They concluded that CMR analysis of ventricular volume, aortic flow, myocardial viability, and stress perfusion all add incremental value for prediction of adverse events over pre-CMR data and can be combined to further enhance prognostication. Normal combined CMR confers a low risk of subsequent cardiac events.